The FLNA gene encodes filamin A, an actin filament cross-linking protein that is ubiquitously expressed within the body. FLNA mutation causes periventricular nodular heterotopia (PVNH) and congenital heart disease. Interstitial lung disease (ILD) related to FLNA mutation has also been reported from 2011 and can be lethal. However, there are no reports of how to combine the treatment of heart disease with the conflicting treatment of lung disease. We herein report cases of two girls with FLNA mutation and both ILD and left-to-right shunts due to congenital heart disease. They presented with respiratory symptoms in early infancy and required management with long-term intubation and ventilation. However, their respiratory status improved subsequent to the closure of their left-to-right shunts even though they were small shunts with improvement in pulmonary hypertension. This suggests that early intervention with closure of cardiac shunts can prevent further deterioration of lung damage.

We are experienced a challenge for the surgeon for tracheocutaneous fistula closure in managing such a complication such as chronic cough, infection and other co-morbidities. The need for a secondary closure is also warranted when the stoma does not close on itself within a specified time.

We hypothesized that the combination therapy of SGLT-2(Sodium-glucose co-transporter-2)inhibitor and Glucagon-like peptide-1 receptor agonist(GLP-1RA) provide renal protection in adults with T2D with estimated GFR (eGFR) below 30ml/minute/1.73 m2. We hereby describe four consecutively treated high renal risk patients with T2D with eGFR between 21 to 30ml/minute/1.73m2.

Regulated or programmed cell death play a critical role in development and tissue organization and function. In addition, it is intrinsically connected with immunity and host defense. Increasing cellular and molecular findings are changing the concept of cell death, revealing an expanding network of regulated cell death modalities and their biochemical programs. Likewise, recent evidences are demonstrating the interconnection between cell death pathways and how they are involved in different immune mechanisms. This work provides an overview of the main cell death programs and their implication in innate immunity not only as an immunogenic/inflammatory process, but also as an active defense strategy during immune response and at the same time, as a regulatory mechanism.

The study reported here concerns the geochemical distributions of macro- and trace elements (including potentially toxic elements, PTEs) in the vineyard soils of Alcubillas, which is one of the oldest, albeit not world-reknowned, wine-growing areas in La Mancha (Central Spain). Soil and leaf samples were analyzed by X-ray fluorescence spectrometry to ascertain the levels of various elements in the soil and the plant. The potential toxicity of the elements was assessed with regard to the development of the vineyard. Despite the fact that fertilizers and pesticides are employed in the vineyards in this area, the results showed that the levels of trace elements in the soil samples did not exceed the reference values according the pedogeochemical values for the region and Spain. This finding suggests that the study area is not polluted. The Biological Absortion Coefficient (BAC) was calculated to assess the assimilation of various elements from the soil to the leaves, and differences were found in the element absorption capacity of the vines. Some elements were not taken up by Vitis vinifera despite elements like Zr and Rb being present in relatively high concentrations in the soil. The production in these soils of grapes and wine does not represent a threat to human health or the ecosystem, because the farmers in this area are extremely careful to preserve the environment and they only farm to achieve moderate yields of grapes per hectare.

Objective: Magill forceps are frequently used to complete the process of nasotracheal intubation (NTI). We aimed to identify a tube core that could facilitate the NTI process conveniently without Magill forceps. Methods: Sixty patients scheduled for oral and maxillofacial surgeries with no differences between the two groups (30 per group) with regard to demographic data were enrolled in our study. In Group M, the wire-reinforced endotracheal catheter was inserted into the trachea using Magill forceps. However, in Group T, a tube core bent to the physiological curve of the nasal cavity lubricated with aseptic paraffin oil was inserted into the endotracheal catheter, and it was then withdrawn after the endotracheal catheter was advanced through the glottis under direct vision. Results: All NTIs were completed successfully, and no Magill forceps were used in Group T. There was a significant difference in total NTI time between the two groups (Group M, 59.7 (5.1) sec vs Group T, 52.4 (3.1) sec). Mild epistaxis was observed in 6 patients in Group M and 5 patients in Group T (6/30 vs 5/30, respectively). There was no presence of damaged oral tissue or damage to the teeth in either group. Conclusion: We conclude that using the tube core, which is a disposable sterilised stylet, for NTI is a convenient choice.

Rationale, aims & objectives: This evaluation was carried out in order to determine the efficacy of the Norfolk and Waveney Adult ADHD Service. With the service not commissioned to offer non-pharmacological support, and with a gap in the research literature, evidence on whether the service model was effective at reducing the impact of ADHD symptoms on service users was needed in order to justify longer term commissioning. Method: Case notes of 113 individuals going through their medication titration process were observed. Scores from the Weiss Functional Impairment Rating Scale (WFIRS), which was routinely collected in the service pre- and post- titration onto ADHD medication, were recorded for comparison. Results: A T test revealed significant improvements in functioning across all domains of the WFIRS after successful titration onto ADHD medication. However, 19.5% of the sample disengaged from the service prior to completing titration. A further 12.5% of the sample did not complete titration due to various factors discussed. Conclusion: While medication has been shown to be effective at improving impairment of functioning in adults with ADHD, high levels of disengagement suggest that more needs to be offered to this population.

Newcastle disease (ND), caused by avian orthoavulavirus type-1 (NDV), is endemic in poultry in the Middle East causing continuing outbreaks in poultry populations despite efforts to vaccinate. In the past, genotype 2.XXI (former 2.VI) was present in poultry in Egypt but has been replaced by genotype 2.VII. We investigated whether virus evolution contributed to superseding, and focused on the antigenic sites within the Heamagglutinin-Neuramindase (HN) spike protein. Full length sequences of a NDV genotype 2.VII isolate currently circulating in Egypt was compared to a genotype 2.XXI isolate that was present as co-infection with vaccine type viruses (2.II) in an historical isolate of the year 2011. Amino acid differences in the HN glycoprotein for both 2.XXI and 2.VII viruses amounted to 11,7% and 11,9 % compared to LaSota vaccine type. However, mutations within the globular head (aa 126-570), bearing relevant antigenic sites, were underrepresented (aa divergence of 8,8% and 8,1 % compared to 22,4% and 25,6% within the fragment encompassing cytoplasmic tail, transmembrane part and stalk regions (aa 1-125) for genotypes 2.XXI and 2.VII, respectively. Nevertheless, reaction patterns of HN-specific monoclonal antibodies revealed differences between vaccine type viruses and genotype 2.XXI and 2.VII viruses for specific epitopes. Accordingly, compared to Egyptian vaccine type isolates and the LaSota vaccine reference strain, single aa substitutions in 6 of 10 described neutralizing epitopes were found within the attachment protein. However, the same alterations in neutralization sensitive epitopes were present in old genotype 2.XXI as well as in newly emerged genotype 2.VII isolates. In addition, isolates were indistinguishable by polyclonal chicken sera raised against different genotypes including vaccine viruses. These findings suggest, that factors other than antigenic differences within the HN-protein account for facilitating spread of genotype 2.VII while displacing genotype 2.XXI viruses in Egypt.

The patients' discouragement from presentation due to the COVID-19 pandemic resulted in the progression of many manageable diseases to a critical condition. we report a case of carbuncle promotion to the necrotizing fasciitis in the context of undiagnosed diabetes mellitus and delay in visiting physicians due to fear of COVID-19.

Early emerging weeds are known to negatively affect crop growth but the mechanisms by which weeds reduce crop yield are not fully understood. In a 4-yr study, we evaluated the duration of weed-reflected light on sugar beet (Beta vulgaris L.) growth and development. The study included an early-season weed removal series and a late-season weed addition series of treatments arranged in a randomized complete block, and the study design ensured minimal direct resource competition. If weeds were present from emergence until the two true-leaf sugar beet stage, sugar beet leaf area was reduced 22%, leaf biomass reduced 25%, and root biomass reduced 32% compared to sugar beet grown season-long without surrounding weeds. Leaf area, leaf biomass, and root biomass were similar whether weeds were removed at the two true-leaf stage (approximately 330 GDD after planting) or allowed to remain until sugar beet harvest (approximately 1240 GDD after planting). Adding weeds at the two true-leaf stage and leaving them until harvest (~1240 GDD) reduced sugar beet leaf and root biomass by 18 and 23%, respectively. It appears sugar beet responded to weed presence by adjusting carbon allocation and leaf orientation to optimize light interception.

Patient with a long history of CLL and known trisomy 12 presented with rapidly rising lymphocytosis, bulky adenopathy, and splenomegaly. Peripheral blood and bone marrow exam showed preponderance of prolymphocytes. Cytogenetic analysis showed an abnormal male karyotype with trisomy 12 and a new t(8;21) translocation in the same 6 metaphases.

Olfactory and gustatory dysfunctions were prescribed in COVID-19 infection. Monitoring and early detection for COVID-19 infection in pregnancy is essential. Keeping rare presentations and the impact they have on the pregnancy in mind is crucial.This is the first case of pregnant woman who had cacosmia as persistent symptoms after infection

This paper considers Capacitated Vehicle Routing Problem(CVRP) in an imprecise and random environment. The deterministic version of the problem deals with finding a set of routes in such a way that the demand of all the customers present in the network are satisfied and the cost incurred in performing these operations comes out to be a minimum. In practical life situations, problems are not always defined in crisp form. Phenomenons like randomness and impreciseness are quite natural to arise in real life. This work presents CVRP in such a mixed environment. In this work, the demands of the customers are assumed to be stochastic in nature and are revealed only upon the arrival of the salesman. Moreover, the edge weights are representing the time required to traverse the edge and hence are both imprecise and random in nature. Different traffic conditions, weather conditions and many other factors corresponds to the random nature of edge weights and varying speed of the vehicle corresponds to the impreciseness. Thus, in this work, edge weights are represented by discrete fuzzy random variables. In this paper, an expectation based approach has been used to deal with randomness. A procedure based on Branch and Bound algorithm has been used to find routes with minimum cost. A numerical example has also been presented to explain the working of the method proposed.

Based on the rainfall data from 197 rain gauge stations for the period 1960 to 2019, linear regression, moving average, and SURFER spatial analysis were used to analyze the temporal and spatial characteristics of rainfall in the Beijing-Tianjin-Hebei region, and compare the difference in rainfall between the mountainous areas and plains, during the flood season. The results show that (1) the overall duration of rainfall in each region of Beijing-Tianjin-Hebei exhibit a downward trend, and the overall spatial performance gradually decreases from east to west. (2) The mountainous areas in the Beijing-Tianjin-Hebei region are prone to light and moderate rainfall events; the plains are more prone to rainfall events at levels above moderate rain, especially rainstorms and heavy rain events; the probability of light and moderate rainfall events in the suburbs is close to that of the urban areas, but the probability of rainfall events at levels above heavy rain is less than that of the urban areas; the probability of rainfall events of all levels in the outer suburbs is higher. (3) Increase in rainfall in urban areas compared to the southern suburbs is greater than when compared with the northern suburbs which are at different stages of urbanization, but the effect of urbanization on rainfall is also reflected in the comparison between the urban areas and the northern suburbs. (4) With increasing urbanization, the built environment in the mountainous areas and plains of the Beijing-Tianjin-Hebei region has continued to grow, and the original underlying surface conditions have changed. Because the urbanization process is faster in the urban areas than in the suburbs, the changes to the underlying surface conditions lead to greater increase in rainfall in urban areas during the flood season compared to the suburbs; the urban areas are also more prone to rainfall events at levels above heav

A document by Josefina Cernadas. Click on the document to view its contents.

Although Zimbabwe has a wealth of livestock genetic resources and mostly are quite agriculturally dependent, there exist clear limitations and challenges regarding animal recording, genetic improvement, production efficiency and the implementation of new technologies, such as genomic selection (GS). Genomic selection incorporates genomic information with phenotypic information (breeding values) to derive genomic estimated breeding values (GEBV) and leads to an increased rate of genetic improvement. The primary principle underlying the application of genomics is that it has the most value for difficult and expensive to measure traits. Maintenance of health will be one of the biggest challenges for efficient livestock production in the next few decades. This challenge will only increase in the face of demand for animal protein, resistance to existing drugs, and the pressure to reduce the use of antibiotics in agriculture. There is probably genetic variation in susceptibility for all diseases but little has been done to make use of this variation to date. In part this is because it is very difficult as well as expensive to measure this variation. This suggests that genomics should provide one of the ways of tackling the challenge of improving animal health. The establishing of reference populations seems beyond the capacity of many, mainly in terms of financial viability, infrastructural support and national cohesion. Genomic technology however holds potential for the introgression of favorable genes in resource-poor livestock production systems and traceability of livestock products. This paper will discuss overview of genomic selection for improved animal health and review challenges and opportunities in Zimbabwe.

Mutualistic associations between plants and arbuscular mycorrhizal (AM) fungi may have profound influences on their response to climate changes. Existing theories evaluate the effects of interdependency and environmental filtering on plant-AM fungal community dynamics separately; however, abrupt environmental changes such as climate extremes can provoke duo-impacts on the metacommunity simultaneously. Here, we experimentally tested the relevance of plant and AM fungal community responses to extreme drought (chronic or intense) in a cold temperate grassland. Irrespective of drought intensities, plant species richness and productivity responses were significantly and positively correlated with AM fungal richness and also served as best predictors of AM fungal community shifts. Notably, the robustness of this community synergism increased with drought intensity, likely reflecting increased community interdependence. Network analysis showed a key role of Glomerales in AM fungal interaction with plants, suggesting specific plant-AM fungal pairing. Thus, community interdependence may underpin climate change impact on plant-AM fungal diversity patterns in grasslands.

A document by Ross Cohen. Click on the document to view its contents.

Purpose: Evaluation of recurrent spontaneous abortions (RSA) can be challenging for a Obstetrician. In case of early first trimester abortions, chromosomal abnormalities can be identified as an important cause. We analysed the RSA cases followed up and diagnosed in the Genetic Clinic or Genetic Lab of 2 hospitals in the region. Methods: Those couples with 3 or more spontaneous abortions were included in the analysis. Karyotyping was one using standard protocol with G-banding and reporting as per ISCN guidelines. Results: Of 97 RSA couples, 20 showed chromosomal abnormalities, and 15 of these had balanced chromosomal rearrangements. The age ranged from 22 years to 37 years, and the median number of abortions was 4. Complex chromosomal rearrangement was seen in 2 couples, in one partner. The spectrum of chromosomal anomalies in couples with RSA is discussed here. Conclusions: Frequency of chromosomal abnormalities in RSA was higher in present study compared to previous studies. Reciprocal translocations were commonest abnormality.

Stress KillsBerhane Worku MD1, Shudhanshu Alishetti2, Kumudha Ramasubbu21. New York Presbyterian Brooklyn Methodist Hospital/Weill Cornell Medical Center Department of Cardiothoracic Surgery, Brooklyn, NY 112152. New York Presbyterian Brooklyn Methodist Hospital Division of Cardiology, Brooklyn NY 11215Corresponding AuthorBerhane Worku MDDepartment of Cardiothoracic SurgeryNew York Presbyterian Brooklyn Methodist Hospital506 6th StreetBrooklyn, NY 11215The medical, economic, and social consequences of the COVID-19 pandemic have been profound. Severe respiratory failure as well as inflammatory and thrombotic complications have resulted in hundreds of thousands of deaths. Political controversy continues regarding optimal strategies for large scale control of the pandemic. Social distancing policies have led to reduced transmission rates but the economic effects have been devastating. Optimal treatment strategies continue to evolve, and vaccine solutions are on the horizon. In addition to these more obvious issues, other severe consequences of the pandemic are slowly being recognized.In the current report, Kir et. al. describe two postmenopausal women presenting with signs and symptoms of acute coronary syndrome in the setting of severe psychological stress related to social isolation during the COVID-19 pandemic (1). Both were COVID negative and both had unremarkable coronary angiograms. Both were diagnosed with takotsubo cardiomyopathy based on the characteristic findings of angina, mild troponin elevation, electrocardiographic changes, and apical akinesis on echocardiogram. Both admitted to severe anxiety and stress in the days prior to the onset of symptoms. Both improved with conservative management including beta-blockers and anxiolytics with resolution of apical akinesis on follow up echocardiogram.Takotsubo or stress cardiomyopathy is a now well recognized entity typically presenting as angina or dyspnea in the setting of a severe emotional or physical stressor. Postmenopausal women are more frequently affected and a history of psychiatric disorders is frequently noted. Electrocardiographic abnormalities and mild troponin elevations are common. Diagnosis is based on the InterTAK diagnostic score. Echocardiography classically demonstrates apical ballooning with basal hyperkinesis, but other wall motion abnormalities are described usually extending beyond a traditional coronary artery distribution. Coronary angiography is frequently performed to rule out acute coronary syndrome but is unremarkable. The syndrome is typically self-limited, requiring conservative supportive management, but in severe cases can lead to heart failure and shock requiring high-dose pharmacologic support, mechanical circulatory support, and in ~5% of cases can be fatal (2).Emotional and physical stress are risk factors for a variety of conditions including cardiovascular disease. Furthermore, psychiatric disorders such as depression and anxiety are associated with poorer outcomes in the setting of cardiovascular disease. Proposed mechanisms for this include behavioral factors such as noncompliance with medications and lifestyle modifications (diet, exercise, smoking cessation). Biological factors are also suggested, including altered autonomic nervous system activity with elevations in catecholamine levels and inflammatory responses amongst others (3). Similar hypotheses have been put forth regarding the mechanism of takotsubo stress cardiomyopathy and perhaps some overlap exists between the cardiovascular manifestations of psychiatric disorders and overt stress cardiomyopathy.The COVID-19 pandemic has had several medical consequences beyond those related to viral infection itself. The suspension of certain medical and surgical services potentially allows for the natural history of various diseases to take their course. Unemployment impairs the ability of many to access what medical services remain available. Psychiatric disorders are inflamed in the setting of social, economic, and other stressors. A four to five-fold increase in the incidence of stress cardiomyopathy has been noted during the months following the COVID-19 outbreak unrelated to COVID-19 infection itself, presumably the consequence of stress related to the abovementioned effects of the pandemic and our response to it. (4). COVID-19 has taught us that stress kills.REFERENCESKir D, Beer N, De Marchena EJ. Takutsobo cardiomyopathy caused by emotional stressors in the Coronavirus Disease 2019 (COVID-19) pandemic era. J Card Surg in pressDe Chazal HM, Del Buono MG, Keyser-Marcus L, Ma L, Moeller FG, Berrocal D, Abbate A. Stress cardiomyopathy diagnosis and treatment. J Am Coll Cardiol 2018;72:1955-71Takagi H, Ando T, Umemoto. Perioperative depression or anxiety and postoperative mortality in cardiac surgery: a systematic review and meta-analysis. Heart Vessels 2017;32:1458-1468Jabri A, Kalra a, Kumar A, Alameh A, Adroja S, Bashir H, Nowacki AS, Shah R, Khubber S, Kanaa’N A, Hedrick DP, Sleik KM, Mehta N, Chung MK, Khot UN, Kapadia SR, Puri R, Reed GW. Incidence of stress cardiomyopathy during the coronavirus disease 2019 pandemic. JAMA Netw Open 2020 Jul 1;3(7):e2014780. doi: 10.1001/jamanetworkopen.2020.14780

Background The coronavirus-disease 2019 (COVID-19) pandemic imposed an unprecedented burden on the provision of cardiac surgical services. The reallocation of workforce and resources necessitated the postponement of elective operations in this cohort of high-risk patients. We investigated the impact of this outbreak on the aortic valve surgery activity at a single two-site centre in the United Kingdom. Methods and Results Data were extracted from the local surgical database, including the demographics, clinical characteristics, and outcomes of patients operated on from March 2020 to May 2020 and compared with the respective 2019 period. The experience of centres world-wide was invoked to assess the efficiency of our services. There was a 38.2% reduction in the total number of operations with a 70% reduction in elective cases, compared with a 159% increase in urgent and emergency operations. The attendant surgical risk was significantly higher [median Euroscore II was 2.7 [1.9-5.2] in 2020 versus 2.1 [0.9-3.7] in 2019 (p=0.005)] but neither 30-day survival nor freedom from major post-operative complications (re-sternotomy for bleeding/tamponade, transient ischemic attack/stroke, renal replacement therapy) was compromised (p>0.05 for all comparisons). Conclusion RBHT managed to offer a considerable volume of aortic valve surgical activity over the first COVID-19 outbreak to a cohort of higher-risk patients, without compromising post-operative outcomes. A backlog of elective cases is expected to develop, the accommodation of which after surgical activity normalisation will be crucial to monitor.

Background: We aimed to evaluate the effect of Bachmann bundle (BB) impairment on electrical and mechanical function of the left atrium (LA), as well as the long-term clinical impact of such impairment. Design: We measured activation time in the five LA walls in 56 patients with atrial fibrillation. LA reservoir, conduit, and contractile function were also evaluated. Patients were divided into two groups based on ablation strategy: the circumferential pulmonary vein isolation (CPVI) group and CPVI with anterior wall linear ablation (LAWA) group. Patients in the CPVI+LAWA group were divided into two sub-groups based on ECG differences following ablation: the BB impairment group and intact BB group. LA activation time and function were then compared between the ablation strategy groups and the CPVI+LAWA subgroups. Results: Patients in the CPVI+LAWA group exhibited longer activation times in the anterior and lateral walls of the LA, poorer LA synchrony, and reduced LA contractile and reservoir function when compared with those in the CPVI group. In the BB impairment subgroup, we observed a discrepancy between electrical/mechanical remodeling. Among five walls, activation time was longest in this region. BB impairment was also associated with reduced LA function. Conclusion: Significant changes in LA function and conductibility were observed in patients with anterior wall ablation, especially those with iatrogenic BB impairment.

We took advantage of a five-decade ‘chronosequence’ of host-microbiome evolution to examine changes in the gut microbiome as wild populations evolve. In an iconic example of rapid evolution in the wild, Trinidadian guppies have displayed parallel phenotypic convergence when translocated six times from high predation (HP) to low predation (LP) environments, but changes in microbiome are unknown. We find microbiomes of fish translocated 5-6 years ago were already more similar to LP native populations than HP sources, and attribute this to both environmental and host-morphological changes. While diet was a minor driver of microbiome structure, we suggest a nutritional role for the gut microbiome in guppy evolution whereby nitrogen-fixing bacteria supplement the low-nutrient diet in LP environments. We show that environment and rapid phenotypic shifts in gut traits interact to control microbiome assembly, and suggest the gut microbiome plays an important but not necessarily consistent role in rapid host evolution.

Adverse effects from the cracks in Reinforced Concrete (RC) structures are controlled at the structural design stage. Cracks due to service load are controlled by limiting the ‘calculated crack width’ to a ‘maximum allowable crack width’. With the understanding of social and economic advantages of long design life structures, there is a trend of constructing structures up to 300 years of design life. To enhance durability, such structures require relatively large concrete cover thickness. The existing ‘crack width calculation models’, have to be validated before using on such large cover structures. The predictions of crack width calculation models in Eurocode 2, Model Code 2010, Japanese Code, American Code and British code were compared with the results of recent experiments with large cover specimens. It could identify that the aforementioned models have to be improved to predict the crack widths of large cover structures. The necessary improvements of each model have been identified. Next, a literature survey was conducted to check the applicability of the existing ‘allowable crack width limits’, for the structures with large concrete covers. To effectively use the existing allowable limits on such structures, the necessary improvements and future works have been identified considering the durability, aesthetic and tightness criteria.